Macular Hole


What is a Macular hole?

A macular hole is a hole in the central part of the retina which is most important for vision. The retina is the innermost light sensitive layer of the eye akin to a film of a camera where the image is formed. 

Macular Hole Symptoms

  • Decrease in  vision
  • Straight lines appearing curved 
  • No symptoms but detected on a routine examination 

Causes of Macular hole

  • Age related  degeneration of the Vitreous (the gel like structure that keeps the eyeball taut)
  • Injury with fist, ball, shuttlecock, firecracker  etc 
  • High  Myopia or short -sightedness
  • Following long standing diabetic maculopathy
  • Solar eclipse viewing 

Who is at risk of developing a macular hole? 

Macular hole is more common in those over 50 years of age and  female gender   

Types of macular holes

Macular hole  progresses through 4 stages  (which are graded onn OCT scan images ). The vision is poorer in stages 3 and 4 compared to  stages 1 and 2 


Diagnosis is made by the ophthalmologist  on a clinical examination  after dilating eyes and viewing the retina under magnification with an appropriate lens .  Since the hole may sometimes be small /subtle an  optical coherence tomography (OCT) scan is almost always done to confirm the diagnosis as well as to measure the size of the hole, determine its stage and predict the outcome of treatment .


 Age related macular holes  of stage 2 and beyond  can be successfully treated with vitrectomy surgery . In this procedure, the vitreous gel from inside the eye is removed , the hole opposed and  a gas bubble  filled inside the eye which self absorbs in 4-6 week period . Some surgeons may recommend a face down position for the initial few days after the surgery to hasten the closure of the hole . Stage 1 holes do not need surgery but  serial check ups to detect progression to subsequent stages is recommended. If the contralateral eye has developed a macular hole more frequent  check ups for the normal eye may be advised . Macular holes secondary to other causes carry a poorer prognosis  


Written by: Dr. Jyothsna Rajagopalan – Consultant Ophthalmologist, Coles Road


What is a Macular hole?

It is a hole in the central part of the retina macula 

 Decrease in vision is the commonest symptom 

Post menopausal female have a slightly higher risk of developing macular holes

Vitrectomy surgery is the treatment and smaller holes of shorter duration have higher success rates 

To ensure the gas bubble opposes the macular hole enabling its closure 


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